الفهرس 
PathologyOnly 14 pages are availabe for public view
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Abstract
The term differentiated thyroid carcinoma (DTC) defines papillary (PTC) and follicular thyroid carcinomas (FTC) and accounts for about 90% of all thyroid carcinomas. Patients with DTC have generally a good prognosis. However, a subgroup of these patients has fatal outcome due to clinical and histological aggressive tumor course.
Hurthle cell carcinoma is a variant of FTC consisting of cancer cells, characterized by trans-capsular and/or vascular invasion, proximal LN metastases, and poor outcome.
Most PTCs that are diagnosed are small and are generally regarded as being low risk, with little or no effect on mortality. It is widely accepted that total thyroidectomy (TT) is the procedure of choice for all PTCS above 10 mm in size.
Lymph node metastases are common finding in PTC, occurring in 20-50% of patients in the central compartment of the neck (level VI) and in 10-30% in the lateral compartment of the neck (levels II—V).
Follicular thyroid cancer (FTC) does not commonly present with cervical lymph node metastases, and when found a follicular variant of PTC should be considered.
Prophylactic central neck dissection (pCND) is defined as resection of level VI lymph nodes that appear normal on preoperative imaging . In contrast, a therapeutic CND is defined as resection of lymph nodes which are clinically or radiographically abnormal.
Although central neck dissection is indicated in clinically nodal positive disease, it remains controversial inpatients with no clinical evidence of nodal metastasis.
Some authors recommend routine central neck dissection in order to prevent a future recurrence, citing the high risk of positive lymph nodes, the accuracy of staging, better outcomes, reduced postoperative thyroglobulin (Tg) levels, and a lower morbidity rate associated with the first operation.
Whereas others suggest that this procedure increases the risk of injury to parathyroid glands and recurrent laryngeal nerves, without any demonstrable benefits in terms of long-term survival.
In view of this ongoing debate about the optimal management of low risk group of DTC in lymph node negative patients. Our main research question was: Is central neck dissection essential in treatment of low risk group of differentiated thyroid carcinoma in lymph node negative patients?
We made a meta analysis for total thyroidectomy + pCND versus total thyroidectomy + no pCND as regard regional recurrence.
The results of this study showed that there is no clear benefit of prophylactic neck dissection in DTC as regard regional recurrence.
Prophylactic central neck dissection should be reserved for high-risk patients only.